Updates to the Discovery CGM Benefit

Discovery Health recently sent out two emails about an update to the Discovery CGM Benefit. Here’s a simple explanation of what they mean.

Who the Discovery CGM Benefit is for

Let’s start with the bad news. This is specifically a benefit for people with Type 1 diabetes. Worldwide, CGM benefits always begin with Type 1s, and then move to Type 2s.

SA Diabetes Advocacy tried hard to get Keycare included this year, but Discovery said that because it’s on such a different pricing model to the other plans, it would be difficult to get the Scheme to agree. They were right, and the request was denied. We will keep trying!

The good news

The benefit has been improved!

• All children with Type 1 diabetes (excluding Keycare) now get two FreeStyle Libre sensors for free a month, or R1,560 towards another CGM.
• Adults on the top two tiers (Comprehensive and Executive) now get two FreeStyle Libre sensors for free a month, or R1,560 towards another CGM.
• Adults on all other tiers (except Keycare) get R780 towards their sensors. If they’re claiming two FreeStyle Libres a month, there’s a R780 co-pay. For one sensor, it’s free.

Requirements to begin the Discovery CGM Benefit

There are still two requirements to start the CGM Benefit, namely:

1. You need a once-off prescription
   From your CGM network doctor.
2. You need to be registered on the Chronic Illness Benefit (CIB) for Type 1 diabetes
   This is what ensures you get all your diabetes medication, so you’re probably already registered!

Co-payments will be funded from available day-to-day benefits, if you have them.

How can you get more cover and additional tools to manage diabetes?

Your cover for diabetes management and treatment starts when you register for the Chronic Illness Benefit. You can get even more cover and additional support if you visit a Premier Plus GP and they register you for the Diabetes Care Programme.

If you register for the Diabetes Care Programme, Discovery pays for these additional benefits without using your day-to-day benefits:

• One additional consultation with a dietitian a year
• One consultation with a biokineticist a year
• For qualifying members, access to a diabetes educator

Understanding the lingo

Although we talk about ‘time in range’ (TIR) or ‘time in target’ a fair amount, there are two new terms that have been introduced now:

• TBR (time below range) for when your blood glucose is below the range set by your doctor (the pre-set number is 3.9mmol/l but you may change this).
• TAR (time above range) for when your blood glucose is above the range set by your doctor (the pre-set number for this is 10mmol/l but you may change it).

Read more about time in range and why it’s important, and find out how to set SMART time in range goals.

Options on the Discovery CGM Benefit

There are currently three options for CGM or flash glucose monitoring in South Africa:

1. Dexcom G6 or G7
2. Abbott FreeStyle Libre
3. Medtronic Guardian or Enlite

You can read more about all three here: Your options on the Discovery CGM Benefit.

Do you have questions?

Reach out to your sensor provider for any other questions – they are there to help!

• FreeStyle Libre: DiabetesCareSouthAfrica@abbott.com
• Dexcom: info@ethitech.co.za
• Medtronic: rs.zadiabetesproductsupport@medtronic.com

Read more about the Discovery CGM Benefit

You can download the Benefit Guide from Discovery, below.

What to read next?

What is a CGM? Flash glucose monitoring and CGM: Not sure what the difference is, or what these words mean? Read this article.

We did it! How to claim the Discovery CGM Benefit: A step-by-step guide to claiming the new CGM Benefit.

Your options on the Discovery CGM Benefit: There are 3 CGM / flash glucose monitors available in South Africa. Here’s what they are, and how much they cost.

Photos by AllGo and Surface on Unsplash